September 8, 2022
When you go to a doctor or a hospital, the reason for your visit (known as an encounter in medical terms) is assigned an ICD code. ICD stands for International Classification of Diseases, which is the worldwide standard for recording healthcare information about human morbidity (disease) and mortality (death). The World Health Organization (WHO) explains the importance of ICD as a common language for recording, reporting and monitoring diseases, allowing the world to compare and share data in a consistent and standard way—between hospitals, regions and countries and over periods of time. The diagnostic information in ICD codes supports data for use throughout healthcare, such as public health records, patient safety and high-value care initiatives, medical device and pharmaceutical development and insurance reimbursements.
Since 1946, WHO has managed the revisions of the ICD. The latest version, ICD-11, went into effect this year. According to the ICD-11 Fact Sheet, “ICD–11 is a vast improvement on previous revisions.” The new coding system is expected to improve ease and accuracy of coding and require less user training. ICD–11 is also ready for use in multiple IT environments with a new API. By transitioning to ICD-11, healthcare organizations will open up numerous possibilities to improve research and patient care.
The BMC Medical Informatics and Decision Making journal article, “ICD-11: an international classification of diseases for the twenty-first century,” highlights these major changes in ICD-11:
- The Foundation database: This database expands how diseases and causes of death can be described and classified. It includes support for multiple languages and details about stages or severity of disease and includes elements to track disease genomics, causes and manifestations as they are discovered. This database also allows for multiple parent and child relationships within the ICD framework to better reflect the complexity of certain diseases. For example, stroke is now in both the neurological and cardiovascular categories (called chapters in the ICD) instead of just being in the cardiovascular category, as in ICD-10.
- Stem codes, extension codes and unique identifiers: ICD-11 includes both stem codes for the main diagnosis and extension codes for related information, such as medication, injury location or disease cause. These codes can be clustered to provide a more detailed record of a patient’s disease. Each concept in ICD-11 also has a unique identifier. These codes and identifiers, along with the APIs the WHO has developed, make it possible for software developers to access and use the ICD coding structure.
- New chapters: ICD-11 has chapters for sleep-wake disorders and sexual health in response to an increased focus on these medical topics since the release of ICD-10. Blood diseases and immune system diseases are now in separate chapters to reflect the differences in the causes and treatment of these diseases. A chapter for traditional medicine concepts enables medical coders to record disease information gathered from a variety of medical environments.
U.S. healthcare organizations currently use a version of ICD-10, ICD-10 CM (Clinical Modification), to classify disease data. The National Center for Health Statistics developed the ICD-10 CM and updates it annually. For example, modifications in the last few years include new codes for vaping-related disorder, COVID-19 and post-COVID-19 condition. Spend any time with the ICD-10-CM Browser Tool and you will appreciate how detailed and complex the ICD can be and why medical coders require specialized training to learn how to apply these codes correctly. Also, you might be left wondering how often the Y93.C1 (Activity, Computer keyboarding) code is used as the cause for an injury.
The U.S. transition to ICD-11 will take several years, although hopefully nowhere near as long as it took to fully transition to ICD-10. After many delays, the ICD-10 was fully implemented in the United States in 2015, 25 years after it was endorsed by the WHO. The National Committee on Vital and Health Statistics, which advises the Secretary of Health and Human Services on these matters, has recommended that the HHS conduct research on how to best implement ICD-11 in the U.S. healthcare system and regularly communicate the status of that research to healthcare organizations to help prevent undue ICD-11 transition costs. In its letter, “Updated Recommendations for Immediate Action on ICD-11,” the committee states, “The need for research is compelling given ICD-11 may, or may not, provide significant opportunity to reduce provider burden and increase interoperability of electronic health information – high priority goals for the U.S.”
At hc1, the hc1 Lab Insights Platform™ ingests ICD codes from an interface with a client’s electronic health record or laboratory information system and stores them in diagnosis records within that client’s hc1 environment. These records can inform insights within different solutions. For example, a client can use these codes to set diagnosis criteria for laboratory test ordering guidelines in hc1 PrecisionDx Advisor. When the U.S. healthcare system fully adopts ICD-11, hc1 will be ready to ingest the expanded data and develop innovative healthcare solutions based on this rich framework.
To learn more about how hc1 can help unlock insights from diagnosis and other patient encounter data, click here to request a personalized demo!